The oral cavity or mouth consists of many parts and can roughly be categorized into hard tissues(teeth and bone) and soft tissues(gums, cheeks, palate, etc.). Optimal function and appearance requires that all the parts are healthy. So when it comes to treating the mouth, it is absolutely imperative to apply a comprehensive approach. I've come across many situations in my career where certain aspects of a condition were ignored during previous treatment and as a result the outcome is poor or failing.
Recently, I did an examination on a patient who just had some restorative work and needed a second opinion because he was not pleased with the results. I found that the patient had moderate to severe bone loss(Periodontitis) and had to tell the patient that all the recent work should be removed in order to treat the supporting bone and gums. Needless to say Mr. X was not happy. The moral of this story is to make sure that a thorough evaluation(clinical and radiographic) is performed before a treatment plan is derived and carried out. As we all know, its always better to do it right the first time!
Tuesday, June 30, 2009
Monday, June 15, 2009
Onlay
As I have mentioned previously, existing restorations in our teeth do not last forever. Due to a constant wear and tear, older fillings tend to break down over the years. It can be somewhat confusing to the average person as to what is an appropriate replacement for an old and defective filling. There are many choices but as a general rule the proper choice for a replacement is directly proportional to how much tooth structure is remaining after the excavation. So the size of the original restoration is definitely a factor. Another factor is the nature and severity of the defect, meaning how much recurrent decay is present at the time of diagnosis. It is also very important to be conservative and not remove any more healthy tooth structure than is necessary.
In my experience most existing defective fillings are best restored with an Onlay. An Onlay is a type of dental restoration that is the best of both worlds not only in the sense that it provides proper coverage but also it is not overkill in preparation. What happens in most situations is that after a defective filling is cleaned out, the walls that contained the old filling will be too thinned out to support another direct filling especially at the very top of the tooth. Those thin walls are then reduced by a couple of millimeters and the Onlay is fabricated in the Laboratory from an impression of the teeth. The analogy that I like to use is a mushroon shape in cross section where the "cap" covers most of the biting surface and the "stalk" sits in the tooth where the filling was. This design is ideal because we are essentially only removing what is defective. It is also relatively more conservative in preparation than some other choices such as a crown for example. The idea is that the more of your own tooth we can hold on to now, the better off you are in the long run and more options are available in the future.
Onlays are made of a type of porcelain and are bonded in with a resin cement. This is a very strong combination and teeth that are restored in this way will typically not require further treatment for many years.
In my experience most existing defective fillings are best restored with an Onlay. An Onlay is a type of dental restoration that is the best of both worlds not only in the sense that it provides proper coverage but also it is not overkill in preparation. What happens in most situations is that after a defective filling is cleaned out, the walls that contained the old filling will be too thinned out to support another direct filling especially at the very top of the tooth. Those thin walls are then reduced by a couple of millimeters and the Onlay is fabricated in the Laboratory from an impression of the teeth. The analogy that I like to use is a mushroon shape in cross section where the "cap" covers most of the biting surface and the "stalk" sits in the tooth where the filling was. This design is ideal because we are essentially only removing what is defective. It is also relatively more conservative in preparation than some other choices such as a crown for example. The idea is that the more of your own tooth we can hold on to now, the better off you are in the long run and more options are available in the future.
Onlays are made of a type of porcelain and are bonded in with a resin cement. This is a very strong combination and teeth that are restored in this way will typically not require further treatment for many years.
Wednesday, June 3, 2009
Interesting facts
In this post, I've decided to keep it light and just list some interesting facts that are dentally related;
The average woman smiles about 62 times a day! A man? Only 8!
Kids laugh around 400 times a day. Grown-ups just 15.
Smilers in school yearbooks are more likely to have successful careers and marriages than poker faced peers.
More people use blue toothbrushes than red ones.
The average toothbrush contains about 2,5000 bristles grouped into about 40 tufts per toothbrush. The tufts are folded over a metal staple and forced onto pre-cored holes in the head and fused into the head with heat. The handle is made of at least two materials, usually plastic and rubber.
Top of the American teeth stakes in the poll for greatest looking teeth were Hollywood actors Brad Pitt and Julia Roberts.
50 % of the general population consider the smile the first facial feature they notice and 80% are not happy with their smile.
38.5 = the total days an average American spends brushing teeth over a lifetime.
Americans spent nearly $2.025 billion on Halloween candy this year. That would fund the National Institute of Dental and Craniofacial Research for almost six years.
33% of Americans have untreated tooth decay.
90% of systemic disease have oral manifestations.
83% of people believe their teeth are more important to their appearance than hair and eyes.
How people take care of their mouths is often a reflection of how they feel about themselves. At birth the only fully developed organ is the tongue which is needed for sucking. For the first two months of life our mouth is our primary organ. We use it for survival, expressing ourselves and to explore our new world. consequently it is very significant in our unconscious. Because of this it can be assumed that how we take care of our mouths is a reflection of how we feel about ourselves. People who feel good about themselves take good care of their mouth and people who have a poor self image generally do not take good care of their mouth.
The average woman smiles about 62 times a day! A man? Only 8!
Kids laugh around 400 times a day. Grown-ups just 15.
Smilers in school yearbooks are more likely to have successful careers and marriages than poker faced peers.
More people use blue toothbrushes than red ones.
The average toothbrush contains about 2,5000 bristles grouped into about 40 tufts per toothbrush. The tufts are folded over a metal staple and forced onto pre-cored holes in the head and fused into the head with heat. The handle is made of at least two materials, usually plastic and rubber.
Top of the American teeth stakes in the poll for greatest looking teeth were Hollywood actors Brad Pitt and Julia Roberts.
50 % of the general population consider the smile the first facial feature they notice and 80% are not happy with their smile.
38.5 = the total days an average American spends brushing teeth over a lifetime.
Americans spent nearly $2.025 billion on Halloween candy this year. That would fund the National Institute of Dental and Craniofacial Research for almost six years.
33% of Americans have untreated tooth decay.
90% of systemic disease have oral manifestations.
83% of people believe their teeth are more important to their appearance than hair and eyes.
How people take care of their mouths is often a reflection of how they feel about themselves. At birth the only fully developed organ is the tongue which is needed for sucking. For the first two months of life our mouth is our primary organ. We use it for survival, expressing ourselves and to explore our new world. consequently it is very significant in our unconscious. Because of this it can be assumed that how we take care of our mouths is a reflection of how we feel about ourselves. People who feel good about themselves take good care of their mouth and people who have a poor self image generally do not take good care of their mouth.
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